{"entity":{"id":"rejuv-history-seasons-of-survival","kind":"term","name":"Seasons of Survival: the 1985 essay that named the problem","aka":["Seasons of Survival","Mullan 1985","Acute, extended and permanent survival"],"tldr":"A physician who had been treated for cancer wrote four pages in the New England Journal of Medicine in 1985 saying that the time after treatment was unmapped territory with hazards of its own. It is the paper the whole field dates itself from.","summary":"Fitzhugh Mullan was a physician who had been treated for cancer; the Institute of Medicine's 2006 report describes him as \"a physician and cancer survivor\". On 25 July 1985 the New England Journal of Medicine published his essay \"Seasons of survival: reflections of a physician with cancer\" across four pages, 270 to 273 of volume 313, with no data in them. Its claim was that survival is not a single state but a sequence, and that each part of the sequence has its own problems which medicine was not then organised to notice.\n\nThe Institute of Medicine's 2006 report quotes the sentence that became the field's charter: \"The challenge in overcoming cancer is not only to find therapies that will prevent or arrest the disease quickly, but also to map the middle ground of survivorship and minimize its medical and social hazards\". The organisation Mullan went on to co-found quotes a second line from the essay on its history page: \"It is as if we have invented sophisticated techniques to save people from drowning, but once they have been pulled from the water, we leave them on the dock to cough and splutter on their own in the belief that we have done all that we can.\"\n\nThe framework the essay set out divides survivorship into three seasons: acute survivorship, which is diagnosis and treatment; extended survivorship, the period of watchful waiting after treatment ends; and permanent survivorship, the long remainder of a life in which recurrence becomes unlikely and the consequences of treatment do not. In 2008 Miller, Merry and Miller revisited the model and added a transitional season between the acute and extended ones, for the specific disorientation of the weeks after treatment stops, when attention, appointments and support fall away at once.\n\nOnCo did not read the 1985 essay itself: it is paywalled and Europe PMC holds no abstract for it, only the record PMID 4010738. Both quotations above are reproduced from sources that quote them, the Institute of Medicine report and the founding organisation's own history page, and the three season names are taken from a 2024 open-access review that describes the framework. That is stated rather than hidden, because an essay this often cited is also often cited loosely.\n\nWhat the essay did not do is as instructive as what it did. It proposed no intervention, measured nothing, and recommended no service. It named a gap. Four decades later the gap is better measured and only partly filled, which is why a four-page essay with no data in it is still the most-quoted document in this field.","asOf":"2026-10-02","links":[{"label":"Mullan, Seasons of survival: reflections of a physician with cancer (New England Journal of Medicine 1985;313:270-273)","url":"https://doi.org/10.1056/NEJM198507253130421"},{"label":"From Cancer Patient to Cancer Survivor: Lost in Transition, executive summary (National Academies Press reader)","url":"https://nap.nationalacademies.org/read/11468/chapter/2"},{"label":"National Coalition for Cancer Survivorship (now Cancer Nation): Our History","url":"https://canceradvocacy.org/about/our-history/"},{"label":"Miller, Merry and Miller, Seasons of survivorship revisited (The Cancer Journal 2008;14:369-374)","url":"https://doi.org/10.1097/PPO.0b013e31818edf60"},{"label":"Shin et al., Exercise across the phases of cancer survivorship: a narrative review (Yonsei Medical Journal 2024), which describes the Seasons of Survival framework","url":"https://doi.org/10.3349/ymj.2023.0638"},{"label":"Europe PMC record for Mullan 1985 (PMID 4010738)","url":"https://europepmc.org/article/MED/4010738"}],"tags":["rejuvenation","survivorship","history"],"related":["rejuv-history-survivorship-movement","rejuv-history-lost-in-transition","rejuv-history-cure-is-not-enough","rejuv-mind-the-word-survivor","rejuvenation-roadmap"],"cancers":[],"sections":["rejuvenation","supportive-care"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":["fitzhugh-mullan"],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"category":"Clinic basics"},"route":"/terms/rejuv-history-seasons-of-survival/","neighbours":{"term":[{"id":"rejuv-history-cure-is-not-enough","kind":"term","name":"Cure is not enough: when late effects stopped being an afterthought","route":"/terms/rejuv-history-cure-is-not-enough/"},{"id":"rejuv-history-lost-in-transition","kind":"term","name":"Lost in Transition: the 2006 report that defined survivorship care, and the care plan it invented","route":"/terms/rejuv-history-lost-in-transition/"},{"id":"rejuv-history-survivorship-movement","kind":"term","name":"The founding of the National Coalition for Cancer Survivorship, and the word survivor","route":"/terms/rejuv-history-survivorship-movement/"}],"technology":[{"id":"rejuv-mind-the-word-survivor","kind":"technology","name":"The word survivor, and why the vocabulary is not a detail","route":"/technologies/rejuv-mind-the-word-survivor/"}],"roadmap":[{"id":"rejuvenation-roadmap","kind":"roadmap","name":"Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it","route":"/roadmaps/rejuvenation-roadmap/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"person":[{"id":"ellen-stovall","kind":"person","name":"Ellen L. Stovall","route":"/people/ellen-stovall/"},{"id":"fitzhugh-mullan","kind":"person","name":"Fitzhugh Mullan","route":"/people/fitzhugh-mullan/"}]}}